Individual
DR. BENJAMIN EDWARD SCHAEFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3280
(217) 383-7071
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
018001918
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019032456
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
10975
TN
Other
Enumeration date
01/26/2016
Last updated
07/31/2020
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